Welcome back to the Bite Me Nutrition Podcast.

Today I want to talk to you about cholesterol and more specifically ways that we can lower our risk promoting cholesterol through diet. So there's a few different types of cholesterol, but the ones we're going to be focusing on are these low density lipoproteins or VLDL LDL, these things that increase our risk of cardiovascular disease.

Cardiovascular diseases contribute to about a third of the world's deaths across the year, which is wild. So if there are some fairly simple swaps that we can all make, which there are to reduce our risk of one of the leading causes of death, I think we should probably be keen to hear more about that.

So, gecko, I don't know if that will come through the microphone. If it doesn't, I'm going to sound really weird. Anyway, what we're going to do is focus primarily on the dietary changes. So things like smoking, stress, exercise, yes, those can all absolutely have an impact. But today I'm just going to be talking about food, because that's what I like talking about.

So the first and probably the most important strategy is one that's going to reduce or stop your increase in LDL cholesterol. So the other strategies are going to help reduce your LDL cholesterol, but this is more about stopping it from going up. The main thing that's going to contribute to your LDL cholesterol increasing outside of genetics and things which we'll go through later, is your saturated fat intake. 

So saturated fat is one of the types of fats that we're going to find in our foods. We're primarily going to find it in fatty cuts of meat, butter or cream. So basically, I know that's dairy, but specifically in sort of churned dairy. So butter and cream and ice cream are churned, whereas things like yoghurt and milk are not. So specifically the churned dairy and coconut products, and also things like baked goods especially, because they've either got a lot of things like butter or shortening, which again, are really high in saturated fat. So the goal is not to get saturated fat to zero, it's just to keep it below to below about 10% of your total daily energy intake, which for most normal levels of energy intake is roughly keeping it under about 20 grams. Now, to put that in context, a tablespoon of butter is about 6 grams of saturated fat. A 200 grams T bone steak is about, I think it's like 12 to 14 grams of saturated fat. So you can see that you could still fit those foods in, but you would need to be mindful of all the other forms of saturated fat in your diet. And so I don't necessarily think it's something that you need to track to the gram. It's more about looking at your food choices and your dietary patterns overall, because those are still going to reduce your saturated fat without you getting too obsessed about a gram. Amount. So what's really important as well is not just lowering your saturated fat intake, but looking at what foods you're using to replace those foods that are high in saturated fat. Because there's a lot of evidence to show that the type of food you replace it with matters. Right? Because in nutrition, that's what we do. We don't just remove the food, we typically replace it. So if you're like, oh, I have a TBone steak every night. I have a T bone steak and salad and chips, fried chips, say, every night. You're not just going to not eat the TBone steak and just have a salad and chips every night, right? You're probably going to put something else instead of the T bone steak on that plate to fill you up. So it is important that we talk about what sort of things you replace those foods with.

And what we want to be doing is we want to be trying to replace them with foods that are high in polyunsaturated fatty acids, monounsaturated fatty acids, or complex carbohydrates. That's not super helpful. So don't worry. We're going to go through what that looks like. Now, basically, foods high in polyunsaturated fatty oh, my goodness. PUFA. I'm going to call them PUFA polyunsaturated fatty acids. PUFA Things like fatty fish, nuts, seeds, tahini, olive oil, other vegetable and seed oils are really great sources of polyunsaturated fatty acids. Oh, there you go. It's coming out now. So looking at if I usually cook with butter, can I swap that for an olive oil? If I'm having lots of butter on my bread, you don't have to cut it by any means. Like I said, it's about staying under that limit. So maybe can I have a slightly thinner spread? Can I replace some of my fattier red meat cuts with some fatty fish or some lean fish or even just some poultry or things like tofu or tempeh, which will be extra beneficial, which we'll talk about in a second. So looking to replace that and also adding in some things like nuts and seeds, whether that be as a snack in a salad, in dishes, all of those sorts of things are going to help increase and sort of increase your polyunsaturated fatty acid consumption and decrease your saturated fatty acid consumption. And that shift in diet we see time and time again has a really positive impact on our blood cholesterol levels.

Monounsaturated fatty acids are also really helpful primarily, again, they're found in similar foods. So we're talking nuts, seeds, avocado, some veggie oils and things. So I'm just kind of living in that world is a really great, great place. And also then, like I said, complex carbohydrates. So we're talking fruits, veggies, grains, nuts, seeds, legumes, lentils. You'll see that I'm going to be repeating similar foods over and over again, and that's because these are the foods that contain all of these good things to help lower your cholesterol so again, focusing on lowering your saturated fat is probably the most important thing you can do to lower your blood cholesterol levels. In terms of dietary cholesterol, it's definitely less important so that's rather than your dietary intake of saturated fat causes you to produce more cholesterol rather than just eating straight cholesterol. That sounds disgusting, but eating foods that contain, pardon me, straight cholesterol, that appears to have a much lower impact on your blood levels of cholesterol. We're primarily talking about foods like eggs and shellfish, which is important to note because those are both really nutritious foods. So it would be a shame to just eliminate them entirely for no real reason. Now, in people who do already have high levels of cholesterol or quite a significant family history of high cholesterol, I would still look to moderate those foods. The current recommendations in Australia, at least for eggs, are, if that is you, with a history risk, you want to stick to below about seven eggs per week and also be mindful of your shellfish consumption. I would say that if you don't have a family history of that, I wouldn't worry too much about your overall intake of those foods.

So we've made those changes to stop our LDL from increasing, and then there's a few other things we can do to look to decrease our current levels of LDL. The cool thing about these next few strategies is they all sort of work independently, which means they work via different mechanisms, which means they stack really well. So we don't kind of reach a point of diminishing returns. It's very much the more of these we can do, the bigger the outcome we're going to have. The first thing is around eating more plants, eating more fruits, vegetables, grains, beans and legumes, which I know once again, shocker a dietician telling you to eat more fruits and vegetables. But there's two very specific reasons why we would recommend this. And the first is around your soluble fiber intake.

So soluble fiber is one type of fiber primarily. You're going to find it quite highly in oats psyllium, husk beans, and then just in lots of varying amounts of fruits and vegetables and nuts and seeds. So just eating a good broad array of those and don't get too stressed about like what fruits are high in soluble fiber, just having a good mix of those, maybe leaning a bit more heavily on oats psyllium, husky beans. If, again, your cholesterol is something you're really focusing on, could be beneficial. But basically what soluble fiber does is it binds to something called bile salts in your small intestine. This means instead of the bile salts hanging out there, they get excreted, you poop them out, basically, which means the body has to make more bile salts, right? Because the more you excrete, the more your body has to make. This is great because to make bile salts, your body has to take cholesterol out of your blood and make small bile salts at your liver. And so this means the more bile salts you excrete, the more cholesterol your body pulls out of your blood. And that's great because it's the cholesterol in your blood that is the dangerous stuff, right? It doesn't matter if you've got lots of cholesterol as bile salts or cholesterol as hormones or cholesterol, because cholesterol is found in lots of different places in the body. That's not the concern, it's the cholesterol in the blood that is the concern. So if we can encourage our body to pull cholesterol out of our blood heck yeah. And soluble fiber does a really, really good job of that.

Another component, or the other main component in plants that we're really interested in, in this space, they're called plant sterols and stanols. So basically they're kind of like the plant equivalent of cholesterol, right? So similar to their similar chemically structured to our cholesterol, which means that we absorb plant sterols in the same way that we absorb cholesterol. And so what this means is if we have more plant sterols, we're going to absorb less cholesterol. Because like I said, they compete. If you can imagine there's one pathway for them to go through. And if all you have is cholesterol, you're going to absorb 100% of that cholesterol. Whereas if you have a 50 50 mix of both, you're going to go one cholesterol, one plant sterol, one cholesterol. It doesn't work that specifically, but you're going to find you're going to absorb a mix of both, which means your overall cholesterol levels are going to lower. So that's pretty awesome. You can find some foods that are fortified with cholesterol. There's like the heart smart milk or you've got like your Flora Proactive margarines. There's weetbix with extra, you know, plant sterols added and things. Those products can be useful. You can also get straight up plant sterol supplements. I wouldn't blanket recommend supplementing with those at this stage.

We need to do a bit more research on it and at the moment there's only kind of like specific scenarios where I would consider supplementation. So it's out there, it's something to talk to your doctor or your dietitian about, if that you think that's of a concern. But basically, if you're focusing primarily on fruit, vegetable, grain, nut, seed, legume, etc. For consumption, you're going to be doing really, really well. The last change that we can look for, which is a bit trickier for some, but still really, really valuable, is looking to replace about 25 to 30 grams of animal protein with soy protein, right? 

That could be tofu or tempeh. Or you might want to replace it with a soy yoghurt or even just a soy protein powder. This is helpful, potentially helpful in a few different ways. Wait, hold on. Sorry. Personally, soy is safe. If you're stressed about soy, I have done another podcast episode on it. I may have written a blog. I don't think I've done a blog. Anyway, there's a podcast episode. Go and listen to that. I'll explain in detail why soy is safe. But if you're already on the same page, then the two main ways in which soy protein intake may help with cholesterol is firstly, you're probably replacing a higher saturated fat food with a virtually no saturated fat food, so that's a win. And the second thing is, there is a little bit of some evidence to show that it might increase your absorption, basically, of cholesterol out of the blood. So, again, like we talked about, that's the critical thing, getting it out of the blood, because it's in your bloodstream, where it does the dangerous stuff, right, where it forms plaque, which increases, can lead to a whole host of other issues. So basically, if soy can increase our LDL absorption a little bit bad, quote unquote, cholesterol absorption a little bit more, then heck yeah, let's go for it. 

So those are what we need to be focusing on, reducing our saturated fat intake, increasing our plant intake to increase our fiber intake and our plant sterile intake, and definitely looking to try and get a bit more soy protein in the place of animal protein. All of those things are going to be super valuable. Now, I just want to quickly touch on something called familial hypercholinemia and just statins and other cholesterol medications in general. I am not for a second suggesting that you stop your cholesterol medication and do these dietary changes. I would strongly suggest doing both and having that discussion with your GP. Maybe over time that will change the way that you're medicated for your cholesterol levels. Maybe it won't, right? The reality is, cholesterol lowering medication is very safe and we're super lucky to have such an effective strategy to combat our own cholesterol. I often have clients who are a bit anti medication or I don't want to go on a statin and things, and I appreciate that, but at the same time, it can reduce your risk so significantly and it's so safe. I strongly don't want this podcast to sound like we're trying to get off that medication. If that's what happens, fantastic. If that's not what happens, fantastic. And the last thing is around something called familial hypercholesterolemia, which is genetic, not even in a condition, but you may be genetically predisposed to higher cholesterol, which means you could do everything that we've just talked about and it's still high. If that's you, you have not failed. You're not a bad person, you don't have a bad diet. That's just the cards you've been dealt. Managing that via diet and cholesterol medication is the best way forward. So all this stuff still applies. You might apply it on top of your current medication routine and be golden.

That's me done. I'm pretty sure my son is crying. Yeah, there he goes. So I'm going to go. Thanks for listening if you found this helpful, I'd love for you to share it with someone who's trying to manage cholesterol or throw it in your stories. And I'll catch you next time.